Provider Demographics
NPI:1699212399
Name:SCHMIEL-DEGAMA, URSULA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:
Last Name:SCHMIEL-DEGAMA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 NW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1242
Mailing Address - Country:US
Mailing Address - Phone:954-639-3611
Mailing Address - Fax:954-746-2544
Practice Address - Street 1:11900 NW 35TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1242
Practice Address - Country:US
Practice Address - Phone:954-639-3611
Practice Address - Fax:954-746-2544
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12946376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator